Prevalence and Correlates of Patient Rationing of Insulin in the United States: A National Survey
Authors: Adam Gaffney, David U. Himmelstein, Steffie Woolhandler
Journal: Annals of Internal Medicine (2022)

Letters18 October 2022Prevalence and Correlates of Patient Rationing of Insulin in the United States: A National SurveyAdam Gaffney, MD, MPH, David U. Himmelstein, MD, Steffie Woolhandler, MD, MPHAdam Gaffney, MD, MPHDepartment of Medicine, Cambridge Health Alliance, and Harvard Medical School, Cambridge, Massachusetts, David U. Himmelstein, MDHunter College, City University of New York, Department of Medicine, Cambridge Health Alliance, Harvard Medical School, and Public Citizen Health Research Group, New York, New York, Steffie Woolhandler, MD, MPHHunter College, City University of New York, Department of Medicine, Cambridge Health Alliance, Harvard Medical School, and Public Citizen Health Research Group, New York, New YorkAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-2477 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Insulin is life saving for many patients with diabetes, but high prices and inadequate insurance coverage may impede access to it. A single-center study (1) and web-based surveys (2) suggest that cost-related insulin nonadherence may be common, although reliable national data are lacking.Objective: To determine the prevalence and correlates of insulin rationing.Methods: We analyzed the 2021 National Health Interview Survey (NHIS) done by the Centers for Disease Control and Prevention, which collected data for 1 randomly selected adult in a nationally representative sample of U.S. households (response rate = 52.8%). We assessed all adults with diabetes who use ...References1. Herkert D, Vijayakumar P, Luo J, et al. Cost-related insulin underuse among patients with diabetes. JAMA Intern Med. 2019;179:112-4. [PMID: 30508012] doi:10.1001/jamainternmed.2018.5008 CrossrefMedlineGoogle Scholar2. Pfiester E, Braune K, Thieffry A, et al. Costs and underuse of insulin and diabetes supplies: findings from the 2020 T1International cross-sectional web-based survey. Diabetes Res Clin Pract. 2021;179:108996. [PMID: 34363862] doi:10.1016/j.diabres.2021.108996 CrossrefMedlineGoogle Scholar3. Mulcahy AW, Schwam D, Edenfield N. Comparing Insulin Prices in the United States to Other Countries: Results From a Price Index Analysis. RAND Corporation; 2020. Accessed at www.rand.org/pubs/research_reports/RRA788-1.html on 15 August 2022. Google Scholar4. Biniek JF, Johnson W. Spending on individuals with type 1 diabetes and the role of rapidly increasing insulin prices. Accessed at https://healthcostinstitute.org/diabetes-and-insulin/spending-on-individuals-with-type-1-diabetes-and-the-role-of-rapidly-increasing-insulin-prices on 15 August 2022. Google Scholar5. Randall L, Begovic J, Hudson M, et al. Recurrent diabetic ketoacidosis in inner-city minority patients: behavioral, socioeconomic, and psychosocial factors. Diabetes Care. 2011;34:1891-6. [PMID: 21775761] doi:10.2337/dc11-0701 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Adam Gaffney, MD, MPH; David U. Himmelstein, MD; Steffie Woolhandler, MD, MPHAffiliations: Department of Medicine, Cambridge Health Alliance, and Harvard Medical School, Cambridge, MassachusettsHunter College, City University of New York, Department of Medicine, Cambridge Health Alliance, Harvard Medical School, and Public Citizen Health Research Group, New York, New YorkDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-2477.Reproducible Research Statement:Study protocol: Not available. Statistical code: Available from Dr. Gaffney (e-mail, agaffney@challiance.org). Data set: Available at www.cdc.gov/nchs/nhis/2021nhis.htm.Corresponding Author: Adam Gaffney, MD, MPH, Harvard Medical School/Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139; e-mail, agaffney@cha.harvard.edu.This article was published at Annals.org on 18 October 2022. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byEnough Is Enough: On the Road to Eliminating "Sophie's Choice" for U.S. Prescription DrugsDarilyn V. Moyer, MD, and Shari M. Erickson, MPHAssessing—and Extending—California's Insulin Manufacturing InitiativeBringing Environmental Sustainability into the Quality Agenda: Time to Act on Reducing Health Care Pollution and Waste November 2022Volume 175, Issue 11 Page: 1623-1626 Keywords Health economics Insulin Type 1 diabetes Type 2 diabetes ePublished: 18 October 2022 Issue Published: November 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...